Take Home Messages:

Depression-related disability in the workforce is steadily increasing. Managing it can be a difficult task.

However recovery can be aided by:

• Discussing the length of work absence with the employee;
• Establishing realistic expectations; and
• Involving the patient in their recovery.

Why the research matters: 

Mental health disorders are increasingly recognised as major contributors to occupational disability and absence. Depression raises the risk of secondary physical and psychiatric illness, as well as for other injuries and accidents.

Knowing the basic issues of managing depression-related occupational disability are essential for  employee’s care and quality of life.

What the research involved:

The study identifies the main concepts in occupational disability and depression by looking at relevant research papers. It discusses practical suggestions for effectively managing occupational disability in patients with depression.

Summary of research findings:

Managing occupational disability in patients with depression is helped by discussing and addressing return to work issues.  The authors point out the following features of depression management that help recovery and return to work.

1. There are advantages and disadvantages of being at work: 
   • Benefits of work absence for the employee include:
     • Being removed from occupational stresses or conflicts;
     • Having more time to engage in activities conducive to recovery – eg: exercise; and
     • Being at less risk for involvement in a work-related injury or accident.
        
   • The negative aspects of work absence for the employee are that the employee may become:
     • Inactive, retreating to bed or the couch – a pattern likely to worsen depression;
     • Isolated without the usual social contacts in the workplace; and
     • Anxious about returning to work after an extended work absence.
     • Research data has shown that the longer an employee is on disability leave, the less likely they are to return to gainful employment. 
   • Participating in the workforce is seen as a positive therapeutic factor. 
2. Establishing realistic expectations; 
   • It is difficult to indicate the expected time needed to restore work function. 
   • Research has found that depression treatment needs to be continued well after the resolution of physical symptom. 
3. Medication and cognitive behavioral therapy have found to be beneficial in treating depression. 
   • Cognitive behavioral therapy focuses on:
     • Goal setting;
     • Problem solving; and
     • Re-engagement.
4. Fostering the patient’s role in recovery 
   • Self-management of chronic or recurrent disorders are likely to re-enforce:
     • Sense of competence;
     • Autonomous decision making; and
     • Goal setting. 
   • Benefits can be seen when encouraging the employee to:
     • Identify workplace issues and actively cope with difficulties in the work situation;
     • Maintain lines of communication with the workplace if on disability leave; and
     • Make a collaborative decision regarding duration of disability leave. 
   • Educating an employee suffering from mild to moderate depression about their condition is associated with high rates of compliance and significant symptom reduction.

Managing depression in an employee returning to work is a challenging task. Actively involving the employee in the decision of returning to work and their role in recovery has been found to be beneficial.

Original research:

Managing depression-related occupational disability: a pragmatic approach.
Bilsker D, Wiseman S, Gilbert M.
Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie 2006;51:76-83.

Link to PubMed abstract